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Nomads' perceptions of quality, accessibility, and affordability of health services as determinants of using skilled birth attendants in Gossi, Mali.
Midwifery 2019; 79:102556M

Abstract

AIM

More than half of all maternal deaths worldwide occur in sub-Saharan Africa (SSA). For nomadic pastoralists (30 to 60 million) in SSA, the risk of maternal death is very high because of the low proportion of assisted deliveries in the areas where they live. The objective of this research was to understand the determinants of using skilled birth attendants in relation to the perceptions of quality, geographic accessibility, and financial affordability of health services by nomadic women.

METHODS

We used a qualitative research design, inspired by ethnography. Research was conducted in the commune of Gossi (Mali), where 90% of the population is nomadic. The study population consisted of 26 nomadic women living in their camps. Saturation and diversification guided sampling. Semi-structured individual interviews and non-participant observation enabled concomitant data collection. Thematic content analysis was performed using QDA Miner software.

RESULTS

Our results show that only 10 women used assisted childbirth for their last delivery. These women thought that health workers were competent and well trained, and they liked the fact that these workers were recruited locally. Similarly, these 10 women deemed the health workers' attitude acceptable and appreciated their availability. In contrast, the majority of participants (16 women) were prevented or discouraged from using skill birth attendants. Some of them did not use them because they were afraid of being undressed, of giving birth on a table, and especially of male staff. They also said that they did not have access to information about health services. In addition, respondents considered health services very difficult to access due to distances, unavailable means of transportation, and costs perceived as being expensive.

CONCLUSION

Our results identify several determinants of the use or non-use of skilled birth attendants by nomadic women in relation to the context and way of life. In addition, our findings call for future research to better understand these determinants and to deepen, refine, and test emerging strategies that seem potentially hopeful with respect to facilitating the use of skilled birth attendance in SSA.

Authors+Show Affiliations

Université Laval, 1050 Avenue de la Médecine, room 3696, Québec, Québec G1V 0A6, Canada. Electronic address: intoucaina@yahoo.fr.Faculty of Nursing Sciences, Université Laval, 1050 Avenue de la Médecine, room 3447, Québec, Québec G1V 0A6, Canada. Electronic address: Louise.Hamelin@fsi.ulaval.ca.Faculty of Nursing Sciences, Université Laval, 1050 Avenue de la Médecine, room 1426, Québec, Québec G1V 0A6, Canada. Electronic address: marie-pierre.gagnon@fsi.ulaval.ca.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31634758

Citation

Ag Ahmed, Mohamed Ali, et al. "Nomads' Perceptions of Quality, Accessibility, and Affordability of Health Services as Determinants of Using Skilled Birth Attendants in Gossi, Mali." Midwifery, vol. 79, 2019, p. 102556.
Ag Ahmed MA, Hamelin-Brabant L, Gagnon MP. Nomads' perceptions of quality, accessibility, and affordability of health services as determinants of using skilled birth attendants in Gossi, Mali. Midwifery. 2019;79:102556.
Ag Ahmed, M. A., Hamelin-Brabant, L., & Gagnon, M. P. (2019). Nomads' perceptions of quality, accessibility, and affordability of health services as determinants of using skilled birth attendants in Gossi, Mali. Midwifery, 79, p. 102556. doi:10.1016/j.midw.2019.102556.
Ag Ahmed MA, Hamelin-Brabant L, Gagnon MP. Nomads' Perceptions of Quality, Accessibility, and Affordability of Health Services as Determinants of Using Skilled Birth Attendants in Gossi, Mali. Midwifery. 2019;79:102556. PubMed PMID: 31634758.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nomads' perceptions of quality, accessibility, and affordability of health services as determinants of using skilled birth attendants in Gossi, Mali. AU - Ag Ahmed,Mohamed Ali, AU - Hamelin-Brabant,Louise, AU - Gagnon,Marie-Pierre, Y1 - 2019/10/10/ PY - 2018/10/15/received PY - 2019/10/01/revised PY - 2019/10/08/accepted PY - 2019/10/22/pubmed PY - 2019/10/22/medline PY - 2019/10/22/entrez KW - Determinants KW - Mali KW - Maternal health KW - Nomads KW - Skilled birth attendant KW - Sub-Saharan Africa SP - 102556 EP - 102556 JF - Midwifery JO - Midwifery VL - 79 N2 - AIM: More than half of all maternal deaths worldwide occur in sub-Saharan Africa (SSA). For nomadic pastoralists (30 to 60 million) in SSA, the risk of maternal death is very high because of the low proportion of assisted deliveries in the areas where they live. The objective of this research was to understand the determinants of using skilled birth attendants in relation to the perceptions of quality, geographic accessibility, and financial affordability of health services by nomadic women. METHODS: We used a qualitative research design, inspired by ethnography. Research was conducted in the commune of Gossi (Mali), where 90% of the population is nomadic. The study population consisted of 26 nomadic women living in their camps. Saturation and diversification guided sampling. Semi-structured individual interviews and non-participant observation enabled concomitant data collection. Thematic content analysis was performed using QDA Miner software. RESULTS: Our results show that only 10 women used assisted childbirth for their last delivery. These women thought that health workers were competent and well trained, and they liked the fact that these workers were recruited locally. Similarly, these 10 women deemed the health workers' attitude acceptable and appreciated their availability. In contrast, the majority of participants (16 women) were prevented or discouraged from using skill birth attendants. Some of them did not use them because they were afraid of being undressed, of giving birth on a table, and especially of male staff. They also said that they did not have access to information about health services. In addition, respondents considered health services very difficult to access due to distances, unavailable means of transportation, and costs perceived as being expensive. CONCLUSION: Our results identify several determinants of the use or non-use of skilled birth attendants by nomadic women in relation to the context and way of life. In addition, our findings call for future research to better understand these determinants and to deepen, refine, and test emerging strategies that seem potentially hopeful with respect to facilitating the use of skilled birth attendance in SSA. SN - 1532-3099 UR - https://www.unboundmedicine.com/medline/citation/31634758/Nomads'_perceptions_of_quality,_accessibility,_and_affordability_of_health_services_as_determinants_of_using_skilled_birth_attendants_in_Gossi,_Mali L2 - https://linkinghub.elsevier.com/retrieve/pii/S0266-6138(19)30247-5 DB - PRIME DP - Unbound Medicine ER -